A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Which of the following
instructions should the nurse include?
Encourage the child to take a 45 min nap daily
Administer prednisone on an alternate day schedule
Apply cool compresses for 20 min every hour
Allow the child to stay at home on days when her joints are painful
The Correct Answer is B
Choice A reason: Encouraging the child to take a 45 min nap daily is not a helpful instruction, as it may interfere with the child's normal sleep pattern and school schedule. The child may benefit from regular rest periods throughout the day, but not necessarily a long nap. ⁵
Choice B reason: Administering prednisone on an alternate day schedule is a helpful instruction, as it is a common way of prescribing corticosteroids for children with juvenile idiopathic arthritis. Corticosteroids are used to reduce inflammation and control symptoms, but they have many side effects, such as growth suppression, weight gain, and osteoporosis. Giving the medication every other day may reduce some of these side effects and improve compliance. ⁶
Choice C reason: Applying cool compresses for 20 min every hour is not a helpful instruction, as it may cause skin damage and discomfort. Cool compresses may be useful for acute inflammation, but not for chronic arthritis. Warm compresses or baths may be more soothing and beneficial for the child's joints. ⁷
Choice D reason: Allowing the child to stay at home on days when her joints are painful is not a helpful instruction, as it may lead to social isolation, academic difficulties, and reduced physical activity. The child should be encouraged to attend school and participate in activities as much as possible, with appropriate accommodations and modifications if needed. The child may also benefit from physical therapy, occupational therapy, and pain management strategies. ⁸
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Asking the parents what caused the bruises is not the best action, as it may not elicit truthful or accurate information. The parents may be the perpetrators of the abuse, or they may be unaware or in denial of the abuse. The nurse should not confront or accuse the parents without sufficient evidence or support.
Choice B reason: Notifying social services is an important action, but not the first one. The nurse should first gather more information and document the findings before making a report. The nurse should also follow the policies and procedures of the health care facility regarding child abuse reporting.
Choice C reason: Asking the toddler what caused the bruises is the best action, as it may provide valuable clues about the source and nature of the injuries. The nurse should use a gentle and nonjudgmental approach, and ask open-ended questions, such as "How did you get these bruises?" or "Who hurt you?" The nurse should also observe the child's behavior and body language, and reassure the child that they are not in trouble.
Choice D reason: Notifying the provider is a necessary action, but not the first one. The nurse should first assess and interview the child, and document the findings. The nurse should also consult with the provider about the appropriate medical care and follow-up for the child. The provider may also assist the nurse in making a report to social services.
Correct Answer is D
Explanation
Choice A reason: Discouraging a high level of fluid intake is incorrect, as hydration is essential for preventing sickle cell crises and reducing blood viscosity. The nurse should encourage the child to drink at least 1.5 times the normal fluid requirement.
Choice B reason: Administering meperidine every 4 hr for pain is incorrect, as meperidine is not recommended for sickle cell pain due to the risk of neurotoxicity and seizures. The nurse should use other opioids such as morphine or hydromorphone for pain management.
Choice C reason: Applying cold compresses to painful, swollen joints is incorrect, as cold can cause vasoconstriction and worsen the sickling of red blood cells. The nurse should use warm compresses or heating pads to promote vasodilation and blood flow.
Choice D reason: Observing for indications of hypokalemia is correct, as sickle cell anemia can cause hemolysis and potassium loss. The nurse should monitor the child's serum potassium level and watch for signs of hypokalemia such as muscle weakness, cramps, arrhythmias, and constipation.
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